A nerve-sparing procedure during robot-assisted radical prostatectomy has been considered one of the most important techniques for preserving postoperative genitourinary function. The reason is that adequate nerve-sparing procedures could preserve both erectile function and lower urinary tract function after surgery. When a nerve-sparing procedure is carried out, the cavernous nerves themselves cannot be visualized, despite the magnified viewing field during robot-assisted radical prostatectomy. Thus, nerve-sparing procedures have been considered challenging operations, even now. However, because not all surgeons have carried out a sufficient number of nerve-sparing procedures, the development of new nerve-sparing procedures or new methods for mapping the cavernous nerves is required. Recently, various new operative techniques, for example, Retzius-sparing robot-assisted radical prostatectomy, transvesical robot-assisted radical prostatectomy and retrograde release of neurovascular bundle technique during robot-assisted radical prostatectomy, have been developed. In addition, new surgical devices, for example, biological/bioengineering solutions for cavernous nerve protection and devices for identifying the cavernous nerves during radical prostatectomy, have developed to preserve the cavernous nerves. In contrast, limitations or problems in preserving cavernous nerves and postoperative erectile function have become apparent. In particular, the recovery rate of erectile function, the positive surgical margin rate at the site of nerve-sparing and the indications for nerve sparing have become obvious with the accumulation of much evidence. Furthermore, predictive factors for postoperative erectile function after nerve-sparing procedures have also been clarified. In this article, the importance of a comprehensive approach for early recovery of erectile function in the robot-assisted radical prostatectomy era is discussed.

Adrenal rest is uncommon in adults, and usually represents a small lesion incidentally detected during surgery or autopsy. The adrenal rest can be detected anywhere along the path of embryonic migration of adrenal cortex, including celiac axis, genitals and broad ligament, and may be formed with the separation of cortical fragments by the migration of medullary elements from the sympathochromaffin tissue into the preformed cortical primordium. In addition, even primary adrenocortical carcinoma is a rare tumor with incidence 0.5-2 per million annually; therefore, adrenocortical carcinoma arising in adrenal rests is extremely rare. We encountered a patient with non-functioning ectopic adrenocortical carcinoma in retroperitoneum. A 34-year-old female presented with an incidentally discovered retroperitoneal mass revealed by abdominal ultrasound in her regular health examinations. She did not have any clinical abnormalities and underwent hand-assisted laparoscopic resection of the tumor. A dark-brown tumor, measuring 65×56×45 mm, was identified in the retroperitoneal space between lower pole of right kidney and inferior vena cava. Histologically, the tumor was predominantly composed of compact eosinophilic cells forming nest-like arrangements and diffusely positive for the steroidogenic factor-1. The tumor met four of the criteria of Weiss used in histological diagnosis of adrenocortical carcinoma (eosinophillic cytoplasm, nuclear atypia, atypical mitosis, and sinusoidal invasion). The tumor cells were immunohistochemically positive for 17α -hydroxylase, dehydroepiandrosterone sulfotransferase and 3β-hydroxysteroid dehydrogenase, each of which is involved in the synthesis of adrenocortical steroids. Therefore, based on these findings, we diagnosed this tumor as ectopic adrenocortical carcinoma arising in adrenal rest of retroperitoneum.

The aim of this meta-analysis was to investigate the effect of pharmacotherapy for overactive bladder on the pathogenesis of urinary tract infection. Materials and Methods: A comprehensive search was performed in MEDLINE and the Cochrane Library using terms for overactive bladder, antimuscarinic agents, and beta 3eadrenoceptor agonists. The primary end point was the emergence of urinary tract infection after pharmacotherapy for overactive bladder. The secondary end point was the emergence of urinary retention, dysuria, and/or increased residual urine volume after overactive bladder treatment. Metaanalyses were conducted using random-effects models. Results: A total of 35,939 patients in 33 trials (29 trials of antimuscarinic agents vs placebo, and 9 trials of beta 3eadrenoceptor agonists vs placebo) that included patients with overactive bladder were identified. At 1-3 months after treatment, the incidence of urinary tract infections was statistically significantly higher in the patients treated with antimuscarinic agents (RR: 1.23, 95% CI: 1.04, 1.45; P [ .013) than in the placebo control group. The incidence of urinary tract infections was not increased in the patients treated with beta 3eadrenoceptor agonists (RR: 1.04, 95% CI: 0.76, 1.42; P [ .796). Antimuscarinic agents also statistically significantly increased the risks of urinary retention, dysuria, and/or increased residual urine volume (RR: 2.88, 95% CI: 1.79, 4.63; P < .001), whereas beta 3eadrenoceptor agonists did not (RR: 1.26, 95% CI: 0.38, 4.14; P [ .708). Conclusions: This meta-analysis showed that antimuscarinic agents statistically significantly increased the incidences of urinary tract infection and lower urinary tract symptoms and dysfunction, but beta 3eadrenoceptor agonists did not. To prevent urinary tract infection emergence, beta 3eadrenoceptor agonists might be safer than antimuscarinic agents.

Background/Aim: The present research was performed to clarify the differences in circulating tumor cells (CTCs) counts between non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer following transurethral resection of bladder tumor (TURBT). Patients and Methods: The cohort in the prospective research was categorized into the NMIBC (n=13) and the MIBC (n=13) groups. The pre-and postoperative number of CTCs was counted by the FISHMAN-R ® system. Results: The difference of the number of preoperative CTCs between the NMIBC group (2.3±2.6) and MIBC group (4.8±4.2) did not reach statistical significance (p=0.08). However, there was a significantly greater increase in postoperative CTC count in the MIBC group (14.6±14.6) than in the NMIBC group (3.1±2.1, p=0.01). Conclusion: After TURBT, more carcinoma cells can be discharged from the bladder in the MIBC. Excessive deep layer resection and excessive pressure of the infusion fluid during TURBT should be avoided in patients with MIBC. Patients and MethodsPatient cohort and design of the study. This single-center, prospective cohort study included the patients for whom TURBT were performed at a university hospital between December 2018 and September 2019. The study protocol was approved by the institutional review board 4299

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